Background

Antimicrobial resistance, known as AMR, is a serious threat to public health. Unchecked, bacteria become resistant to more antibiotics until infections become untreatable. By 2050, some predict more people will die from AMR than cancer.

Urinary Tract Infections, or UTIs, are the most common bacterial infection treated in the NHS, mostly using antibiotics prescribed by GPs and nurses.

Recent research suggests up to 50% of bacteria which cause UTIs are resistant, resulting in longer, more severe infections, requiring multiple antibiotic courses and in some cases hospital admission.

GPs and nurses have recently been encouraged to prescribe nitrofurantoin instead of trimethoprim (both first-line antibiotics for UTI). Some studies suggest this reduced trimethoprim AMR rates, but not everywhere, and concerningly may have led to higher AMR against other antibiotics.

These results lead policy makers to ask two key questions:

1. Are these results reliable?
2. What should be done?

Firstly, the data are not reliable (because methods used mean there could be other reasons for the changes), and secondly, nobody knows what to do next. There are lots of ideas, but we do not know if the benefits will outweigh the harms.

Design

A randomised controlled trial (RCT) is the only reliable way to investigate the effects of a medicine. The IPAP-UTI study will be conducted in the areas with the worst AMR problems in the UK, and will include the groups most affected. We will report differences across socioeconomic and ethnic groups.

We will conduct three RCTs, with some GP practices (randomly chosen within our target areas of high AMR) receiving an intervention encouraging them to use an alternative antibiotic, and the rest continuing with usual care.

At the end of the study, we will compare antibiotic use and AMR rates between the two groups. We expect that any differences will be due to the intervention.

Funding

This study is funded by the National Institute for Health and Care Research (NIHR) under its Programme Grants for Applied Research Programme (Ref:NIHR204400). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. 

Collaboration

The IPAP-UTI programme is a collaboration between the UK Health Security Agency (UKHSA), Bristol, North Somerset and South Gloucestershire Integrated Care Board (BNSSG ICB) and the University of Bristol.

Investigators

The IPAP-UTI programme is led by Dr Ashley Hammond and Professor Alastair Hay from the Centre for Academic Primary Care at the University of Bristol.

Contact

To contact the study team, email: ipap-uti@bristol.ac.uk

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